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TMSIS Dataguide Medicaid.gov

Version:

3.39.0

RULE-710

Validation Rule
Last updated

No Updates

Tier 2.0
Tier Description Relational error
Error Category E2001
Error Category Message Values inconsistently specified (single record type, single record)
Rule Type One Record Type (Single Record)
File Segment Number CIP00002
Data Element Name CLAIM-HEADER-RECORD-IP.DRG-OUTLIER-AMT
Validation Logic 'if CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.OUTLIER-CODE is equal to one of the following: '00', '09', then CLAIM-HEADER-RECORD-IP has a null value for DRG-OUTLIER-AMT or CLAIM-HEADER-RECORD-IP.DRG-OUTLIER-AMT equals '0.00''
Rule Definition If a claim is a non-denied claim from an IP file, and the outlier code is equal to '00' or '09', then the DRG outlier amount must be 0 or null.
Denominator Logic # of IP claim headers with CLAIM-HEADER-RECORD-IP.CLAIM-STATUS-CATEGORY does not equal 'F2' and CLAIM-HEADER-RECORD-IP.OUTLIER-CODE is equal to one of the following: '00', '09'